This once common childhood illness may not always be harmless and routine,
but you can guard against its possible complications simply by being immunized
against the disease.

Measles is a viral infection which is passed from person to person, like many
others, on the tiny drops of moisture we constantly breathe in and out. It's
very infectious, and few children will escape a bout of measles between the ages
of one and six unless they are protected.

Very young children have natural immunity, inherited from their mothers,
which protects them for several months. Measles is rare in older children and
adults, largely because having the disease once provides immunity for life.

However, from the age of about one year, all children are at risk, and in
most developed countries it is routine to offer immunization against measles to
all children in their second year of life. As a result, the disease has almost
been eradicated in the United States and many other countries.

REGULAR EPIDEMICS

In those areas where few children have been immunized, springtime epidemics
of measles tend to occur, for reasons that are not fully understood, every two
or three years. In these circumstances, measles and its complications can be
life-threatening, especially if the child who catches it is already suffering
from malnutrition.

FIRST SIGNS

Once caught -- usually one exposure to an infected child is enough -- measles
shows no symptoms for seven to 12 days. During this time the virus is
incubating, or multiplying in the cells of the throat and the passages leading
down to the lungs.

After this, the child develops what seems to be a heavy cold, with a runny
nose, husky cough and red and watery eyes. There may be a fine, red rash that
lasts a few hours. Temperature may rise to 38°C (100.4°F), and sickness and
diarrhoea are possibilities, although some children have no fever at all, and
other symptoms may be very mild.

KOPLIK'S SPOTS

If you examine the inside of the
child's mouth at this stage, you will see tiny, white spots lining the cheeks
that look like grains of salt surrounded by a rosy, slightly inflamed area.
Known as Koplik's spots, after the man who first identified them, these spots
are unique to measles.

THE RASH

After three or four days --
occasionally five to seven -- the temperature falls and the rash appears. This
takes the form of slightly raised spots, typically a dark red in color, which
group together in patches to give the blotchy appearance most people think of in
association with measles. Sometimes there is a slight itching, sometimes none at
all.

The rash first appears behind the
ears, then spreads to the neck and forehead, eventually covering the face and
trunk and, in severe cases, the arms and legs. This usually happens over a
period of 24 hours.

The day that the rash starts to
appear the child's temperature begins to rise again. This is the time when he is
likely to feel most ill, and in severe cases absolutely wretched. The cough is
at its worst, and soreness in the eyes tends to make light very irritating.
Complications, if they are to occur, begin to develop at this stage.

QUICK RECOVERY

Over the next three days, the rash
disappears in the order in which it appeared, leaving behind a brownish staining
of the skin which fades as the skin peels. As the rash organs. Haemorrhagic
measles, as this is known, is life-threatening and requires hospital treatment.
Though the tiny haemorrhages that may occur in the rash of mild measles are no
cause for alarm, you should call a doctor immediately if there is more
widespread bleeding.

INFECTIONS

More common complications are the
result of the body's immune system being weakened, allowing bacterial infections
to take hold. Measles temporarily destroys the lining of the passage leading to
the lungs. This paves the way for bacteria to infect nearby areas such as the
ears and lungs. If your child has earache, or a discharge of pus from the ears,
tell a doctor immediately, as a course of antibiotics will prevent the infection
from spreading and clear it up.

If a child suffering from measles develops a chesty or wheezy cough, producing
phlegm, rather than the dry, throaty cough typical of measles, this is a sign of
a lung infection, or, bronchitis. Again, inform the doctor straight away, as
antibiotics can prevent any permanent damage to the lung.

CAUSE FOR WORRY
In young children, measles can lead to bacterial infection of the larynx or
'voice box' which obstructs the breathing and produces a hoarse, croaking,
'croupy' cough. This is a serious complication but, fortunately, is less of a
problem due to the now widespread use of the Hib vaccine.

While mild conjunctivitis -- an irritation of the whites of the eyes -- is
normal in measles, a secondary bacterial infection, producing a thick, sticky
discharge, can cause scarring, and even blindness. Again, inform the
doctor if you see any signs of this.

The worst complication of measles is encephalitis, an inflammation of the brain
and central nervous system. The symptoms of this are drowsiness, hallucinations
and delirium, occurring about 10 days into the
illness. It is very rare, developing in no more than one in 1,000 cases, but it
needs hospital treatment because the consequences, including permanent
personality changes, are so severe.

TREATMENT
Mild cases of measles need no treatment other than home nursing. More severe
ones need more intensive nursing and plenty of reassurance for the patient, but
even here there is no need to retire to bed unless they are feeling too unwell
for anything else. Some doctors give antibiotics to all measles patients, while
others do not unless the case is particularly severe or there are possible
complications.

IMMUNIZATION
Measles immunization, which gives a high level of lifelong immunity, is
routinely offered in the second year of life in many countries, and it makes
sense to have your children immunized unless you have a specific reason not to.

In many countries, immunization against measles is combined with protection
against mumps and rubella (German measles) in the MMR vaccine. The side-effects
are usually very mild, with just a slight rash 10 days or so later.